A 49 year woman stepped into Denty’s Vijayawada with a chief complaint of spacing between upper anterior and prominent upper arch. On clinical and radiographic examination, the patient has been diagnosed to be suffering from chronic generalized periodontitis. The other prominent findings were proclined incisors, prominent pre maxilla, incompetent lips with high frenal attachment which is encroaching on to the crest.
Patient’s priority is to have competent lips and an aesthetic smile. So a comprehensive plan was designed after making impressions and diagnostic wax up to meet the patient’s needs. The Plan followed with Flap surgery to achieve periodontal health and to decrease the proclination of maxillary anterior by extraction of incisors and to reduce premaxilla by Dean’s inter septal alveolaplasty (modified to save canines), Frenectomy was done to relieve high frenal attachment and immediately a temporary bridge was designed to align the maxillary anterior to achieve esthetics. Permanent fixed prosthesis was planned after complete healing. Ideally, an all ceramic bridge would have given the best esthetic outcome. Patient’s occlusion and length of edentulous space contraindicated the all ceramic prosthesis.
Position of mandibular anterior teeth which were labially placed was a challenging task during prosthetic replacement in labio-lingual direction.
Team involved Dr. Kiran Kumar. M.V., Dr. Vamsi Krishna, Dr. Pallavi Samatha Yalamanchili, Mr. Avinash (Denty’s lab technician)
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